Journal of Modern Medical

Introduction
The growth in the number of older people as a silent revolution is a phenomenon of the 21st century in developed and developing countries. It is expected that the elderly population will make up 16% of the world’s population and 29.45% of Iran’s population by the end of 2050. The increasing elderly population increases the risk of living with diseases that affect normal activities of daily living such as non-communicable diseases. Considering the complicated etiology, slow onset, and long progression of chronic diseases that affect more than 80% of the elderly, self-care can be an effective way to control these diseases. Self-care refers to a set of knowledge and skills to take care of oneself which is used daily as primary and cost-effective care and a way to maintain health and self-esteem in developed and developing countries. The most important factor affecting self-care behaviors is the health literacy of patients. The low level of health literacy interferes with understanding health information and receiving health services. Due to the increase in chronic diseases and the consequent increase in medical expenses, self-care and health literacy play an important role in managing the daily life of the elderly. The present study aims to investigate the status of self-care and health literacy in the elderly in Iran.

Methods
This review study was conducted in 2021 by searching in national and international databases including Scopus, ScienceDirect, PubMed, Web of Science, DOAJ, Magiran, Iranmedex and Scientific Information Database (SID) and Google Scholar for studies conducted in Iran from January 2005 to May 2021. The search was performed using the keywords “self-care”, “health literacy”, “Iran”, “elderly” and “elderly people” using Boolean operators (“AND” and “OR”). Retrieved studies were screened based on title and abstract to remove duplicates and identify relevant studies. The qualitative, quantitative and mixed-method studies published in English or Persian languages with available full texts were included in the review. Letters to the editor, conference papers, editorials, books, review studies, theses, and articles whose full text was not available were excluded from the study. The initial search yielded 508 articles. After examination and removal of duplicates, 337 articles were selected, of which 125 were selected based on inclusion and exclusion criteria. Finally, based on the PRISMA checklist, 36 articles (17 articles in English and 19 articles in Persian) were selected for the review.

Results
In this study, 36 articles in the field of self-care and health literacy of the elderly in Iran were reviewed (23 articles assessing the levels of self-care in the elderly and 13 articles assessing the health literacy status of the elderly). Of 36 articles, 13 were quasi-experimental interventional studies, 21 were cross-sectional descriptive (analytical) studies, one was a qualitative study and one was a clinical trial. All articles assessed the elderly living in Iran, except for one article that examined Iranian elderly living in Dubai. Based on the review of these articles, it was found that the self-care and health literacy of Iranian elderly were at a low level. Table 1 summarizes the results of all the articles reviewed in this study.



Discussion
The results indicated that the Iranian elderly do not have adequate health literacy and their self-care behaviors are at a low level. This is a warning for the providers of health services in Iran, because the decrease in the level of health literacy can lead to a decrease in self-care behaviors and increase the cost burden on the health system. Therefore, it is necessary for the national health system to pay more attention to the health literacy of this vulnerable group. In addition, it is recommended that suitable educational interventions be implemented with a focus on promoting self-care behaviors of the elderly to create and strengthen the positive attitudes of the elderly in self-care. The current study had some limitations and weaknesses. For example, most of the articles had no available full texts and were excluded from the study process. Another limitation was the lack of study on self-care status and health literacy level based on gender in the reviewed studies. A further study is recommended to compare the status of self-care and health literacy in older men and women in Iran.

Ethical Considerations
Compliance with ethical guidelines
Since this is a review study, there was no ethical principles to be considered.

Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors' contributions
Methodology and data collection: Akhtar Sayadi; Writing: Siddiqa Abedini; Data analysis and writing: Samira Abedini; Supervision: Hossamuddin Kamalzadeh; final approval: All authors.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors would like to thank the Student Research Committee and the Deputy for Research and Technology of Hormozgan University of Medical Sciences.

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